Clinical procedural skills assessment during internship in ophthalmology

Introduction: Directly observed procedural skills (DOPS) is aunique method for assessment since it tests the trainee’s abilityto apply his knowledge and skills in performing a particularprocedure and provides an assessment of the practical workperformed by the trainee on a ‘real’ patient under supervisionof an experienced faculty. The study aims to make use of DOPSrating for assessment and further improvement in proceduralskills in interns in Ophthalmology rotational posting.Methods: A prospective study was planned and 15 interns on 2weeks’ rotational posting in the department of Ophthalmologywere included by purposive sampling over a duration of 2months. Four clinical procedural skills were identified and in thesecond week of posting, the interns were assessed by three DOPSencounters at an interval of 2 days for each clinical skill. TheDOPS ratings were analyzed quantitatively using R-statisticalsoftware by repeated measure ANOVA and Banfuroni test.Results: A total of 180 DOPS were undertaken for 15 internsin 4 core areas of ophthalmic examination. The mean overallDOPS rating for DOPS-1 was 3.70±0.82, DOPS-2, 3.83±1.82and DOPS-3, 4.93±1.65; the difference in DOPS rating betweenthe first and second encounter was not statistically significant(p=0.497), between the second and the third and between the firstand the third were statistically significant (p=0.000 in both cases)using Banfuroni test. The overall difference was also statisticallysignificant (p=0.000) using repeated measure ANOVA. Both theassessor and intern satisfaction increased significantly from thefirst to the third DOPS, but not statistically significant between thefirst and the second and between the second and the third DOPS.Conclusions: We found significant improvement in interns’clinical skills through repeated DOPS and the method waswell accepted by both the students and the faculty. Internshipperiod can be well utilized for improving clinical skills andnovel performance assessment methods like DOPS might proveto be highly beneficial in ensuring adequacy of learning duringinternship and also to assess their readiness for acceptingprofessional responsibilities in future.Keywords: Assessment, Ophthalmology, Internship